Healthcare Provider Details

I. General information

NPI: 1659407773
Provider Name (Legal Business Name): KIMBERLY M. LUMPKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

29 S GREENE ST STE 110
BALTIMORE MD
21201-1504
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-4089
  • Fax: 410-328-5919
Mailing address:
  • Phone: 410-328-4089
  • Fax: 410-328-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberD64246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: